Mixed Deck — All Certified Medical Coding Specialist Topics Flashcards
100 cards from real Certified Medical Coding Specialist practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 20 Mixed Deck — All Certified Medical Coding Specialist Topics flashcards as text
A coder receives pressure from a practice manager to upcode a procedure to increase reimbursement. The coder should:
Answer: Refuse and report the request through the compliance hotline or chain of command
Upcoding is fraudulent; the coder must refuse and report the request through appropriate compliance channels.
Which of the following is an example of a 'never event' as defined by CMS that affects hospital reimbursement?
Answer: Wrong-site surgery
Wrong-site surgery is classified as a 'never event' or serious reportable event; CMS does not reimburse for the additional costs of treating conditions that result from these events.
Which document provides the most authoritative clinical evidence to support a risk-adjusted diagnosis code?
Answer: The signed physician progress note or visit documentation
Signed physician documentation in the medical record is the gold standard for supporting risk-adjusted diagnosis codes.
What is the role of professional journals in Certified Medical Coding Specialist practice?
Answer: They disseminate current research, best practices, and professional developments
This is fundamental to Certified Medical Coding Specialist practice. They disseminate current research, best practices, and professional developments represents the professional standard for research in the Certified Medical Coding Specialist certification framework.
Which federal act established the National Correct Coding Initiative (NCCI) to prevent improper coding?
Answer: The Omnibus Budget Reconciliation Act of 1993
NCCI was established under OBRA 1993 to promote correct coding and control improper coding that leads to inappropriate Medicare payments.
HCPCS Level II S codes are primarily used by which payers?
Answer: Non-Medicare payers such as private insurers and managed care organizations
S codes are temporary national codes used primarily by non-Medicare payers such as private health insurers and managed care organizations.
Which term describes the surgical creation of a new opening into the colon?
Answer: Colostomy
A colostomy is the surgical creation of an opening (stoma) from the colon to the abdominal wall, using the suffix -ostomy (new opening).
A provider documents 'history of MI' for a patient who had a myocardial infarction two years ago with no current symptoms. How should this be coded?
Answer: As old myocardial infarction using the appropriate personal history code
An MI that occurred more than four weeks ago is coded as old or healed MI using the personal history or old MI code, not as acute.
What is the purpose of placeholder character 'X' in ICD-10-CM codes?
Answer: To allow for future expansion and maintain the required code length
The placeholder X is used in ICD-10-CM to allow codes to reach the required length and reserve space for future expansion.
How do Certified Medical Coding Specialist professionals evaluate research quality?
Answer: By assessing methodology, sample size, peer review status, and relevance to practice
This is fundamental to Certified Medical Coding Specialist practice. By assessing methodology, sample size, peer review status, and relevance to practice represents the professional standard for research in the Certified Medical Coding Specialist certification framework.
The medical term 'nephro-' refers to which organ?
Answer: Kidney
The prefix 'nephro-' refers to the kidney, as seen in nephrology (study of kidneys) and nephrectomy (removal of a kidney).
Which CPT code range covers Evaluation and Management (E/M) services for hospital inpatient care?
Answer: 99221-99223
CPT codes 99221-99223 are used for initial hospital inpatient care services.
What is a CPT add-on code, and how is it identified?
Answer: A supplemental code always reported with a primary code, marked with a '+' symbol
CPT add-on codes are identified by a '+' symbol and are always reported in conjunction with a primary procedure code, never alone.
The 'minimum necessary' standard under HIPAA requires covered entities to:
Answer: Disclose only the PHI needed to accomplish the intended purpose
The minimum necessary standard limits PHI disclosure to only what is required to fulfill the specific purpose.
A surgeon performs a complex repair of a 4.5 cm laceration of the neck and a simple repair of a 2.0 cm laceration of the arm during the same encounter. How are these coded?
Answer: Code both repairs separately using appropriate CPT codes
Repairs of different complexity (simple vs. complex) at different anatomic sites are coded separately with their respective CPT codes.
Which of the following is a characteristic of a leading or directive physician query?
Answer: It asks 'Would you agree that this is sepsis?' without other options
A leading query suggests the desired answer and is non-compliant; compliant queries offer clinically supported options or open-ended choices.
A medical coder who identifies a suspected compliance violation in their department should FIRST:
Answer: Report through the organization's internal compliance hotline or to the compliance officer
Established compliance programs require that suspected violations be reported internally through designated channels such as the compliance hotline or compliance officer.
When a compliance officer requests documentation of coding decisions, the coder should:
Answer: Supply complete, accurate documentation of the coding rationale
Full, accurate documentation supports transparency and demonstrates compliance with coding standards.
A patient with type 2 diabetes presents with a diabetic foot ulcer on the right heel. The documentation states the ulcer is limited to the skin. Which ICD-10-CM code set is most appropriate?
Answer: E11.621, L97.419
E11.621 captures type 2 diabetes with foot ulcer, and L97.419 identifies the right heel ulcer limited to the skin with unspecified severity.
What does the abbreviation NEC stand for in ICD-10-CM?
Answer: Not Elsewhere Classified
NEC stands for 'Not Elsewhere Classified,' indicating the coder has a specific condition but no specific code exists for it.